AccountId: 011433970860
ContactId: 6ae1a87a-d39e-4085-a3f7-306b288b31d3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 334029 ms
Total Talk Time (AGENT): 129023 ms
Total Talk Time (CUSTOMER): 144668 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/6ae1a87a-d39e-4085-a3f7-306b288b31d3_20250331T17:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], it's [PII] in group billing. I have an insured on the phone that's got um a claims question.
[AGENT][NEUTRAL] OK alright and what number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and what's the patient?
[AGENT][NEUTRAL] name
[CUSTOMER][NEUTRAL] So [PII].
[CUSTOMER][POSITIVE] uh, that I think that's how she said it. Her accent is very strong.
[AGENT][NEUTRAL] OK. All right. And you verified her?
[CUSTOMER][NEUTRAL] And her
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yes, ma'am, and her callback number is the same that's on the policy.
[AGENT][POSITIVE] OK perfect alright go ahead and put her through.
[CUSTOMER][POSITIVE] All right. Here she comes. Thanks.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Hi uh this is [PII] with the care team so I understand you have some um claims questions.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. All right. I've got your policy pulled up.
[AGENT][NEUTRAL] And do you have the claim number that you're in question about?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, so, uh,
[CUSTOMER][NEUTRAL] Um, I think because like, I, I made an appointment and then they say, oh, I had to, I have to pay it out of my pocket, something that stuff like that. So I can set the appointment so I don't have like, I, I don't uh see it yet, but I want to know before I make an appointment that how much I have to pay it.
[CUSTOMER][NEUTRAL] For the uh colonoscopy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, for the colonoscopy, let me see.
[AGENT][NEUTRAL] Pull it up real quick.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so when the payment was made, and this is just to verify your benefits, it's not a guarantee of payment.
[AGENT][NEUTRAL] It was made for the $50 it maxed out the benefit payable for that date of service, so it paid the most it could pay.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But it, it, I want to do the colonoscopy. So,
[CUSTOMER][NEUTRAL] So, uh
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I wanna do the colonoscopy at the Swedes Hospital. So it's in the hospital, uh, Sw D hospitals in the network or out of network?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. So your diagnostic testing benefit.
[AGENT][NEUTRAL] Um, pays a maximum of $100.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For the colonoscopy.
[CUSTOMER][NEUTRAL] That I have to pay $100 or?
[AGENT][NEUTRAL] Are you there?
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am. So that, um, the policy pays a maximum of $100.
[CUSTOMER][NEUTRAL] Oh, so, uh, that means you guys pay only $100 right? So the, I have to pay it.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh, I don't know how much they charge it.
[AGENT][NEUTRAL] Right, you'll have to get with the um provider and see how much they charge for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and then they'll have to send in the claim for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But like, uh, depend on the hospital or the some hospital or provider is not in network or it's out of network?
[AGENT][NEUTRAL] No, there's not a network. You can use whoever you want to use. Um, it's just the diagnostic testing benefit is a 100 day maximum of 1 day per calendar year per covered person, um.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] The outpatient.
[AGENT][NEUTRAL] Uh, sickness for, uh, let's see, you don't, that's for sure. Look and see if there's anything else.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, that is what the benefit pays.
[AGENT][NEUTRAL] One day a calendar year.
[AGENT][NEUTRAL] On this policy.
[CUSTOMER][NEUTRAL] One day and hit the hold.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] That means I, they pay only 100.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Dollar.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're very welcome. Is there anything else so I can help you with?
[CUSTOMER][NEUTRAL] No, I just want to know about that. So I want to, because the doctor request me to do the colon colonoscopy something.
[CUSTOMER][NEUTRAL] But they say I have to pay it out of pocket. So I want to know before I make an appointment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, I understand.
[CUSTOMER][POSITIVE] OK. OK. Thank you.
[AGENT][POSITIVE] All right. Well, you have a wonderful day and thank you for calling APL.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] Yeah, thank you. Bye-bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.